ORGOVYX Support Program logo

We are dedicated to providing ongoing support to help patients
prescribed ORGOVYX start and stay on track.

CHOOSE 1 OF 3 EASY WAYS TO ENROLL YOUR PATIENTS TODAY
Download the ORGOVYX Support Program Start Form icon
DOWNLOAD

Download the ORGOVYX Support Program Start Form, print, and complete the form, then fax it to 1-844-826-8875.

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CALL

Call toll-free 1-833-ORGOVYX
(1-833-674-6899)
,
Monday-Friday, 8 AM-8 PM ET.

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E-PRESCRIBE

When e-prescribing ORGOVYX to the TC Script pharmacy, enrollment in the
ORGOVYX Support Program is available.

The ORGOVYX Support
Program Includes:

ORGOVYX Copay Assistance Program Card
Financial Assistance*

Copay assistance is available for eligible
commercially insured patients for as little as
$10 per month. See Terms and Conditions
below.

Enroll patients
ORGOVYX Bridge Program icon
ORGOVYX Bridge Program

Eligible commercially insured patients who are experiencing coverage issues can receive ORGOVYX at no cost for a limited period of time. See Terms and Conditions below.

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Reimbursement Support

We can help assist your patients with access challenges, including benefit verification, providing information about prior authorizations, and appeals processes.

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Nurse Support

Nurse Support is available to help answer patients’ general questions about ORGOVYX and offer lifestyle tips.

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ORGOVYX Education

Provides educational resources to help support patients.

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Additional Resources

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FORMULARY LOOKUP TOOL

Find coverage information for patients in different ZIP codes.

Search your area
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DISTRIBUTION NETWORK

Find which pharmacies are eligible to order ORGOVYX.

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ORGOVYX COPAY ASSISTANCE PROGRAM: TERMS AND CONDITIONS

*The ORGOVYX Copay Assistance Program (“Copay Program”) is for eligible patients with commercial prescription insurance for ORGOVYX. With this Copay Program, eligible patients will pay as little as $10 per month, subject to a maximum of $10,000 per calendar year. After the annual maximum of $10,000 for ORGOVYX is reached, patient will be responsible for the remaining monthly out-of-pocket costs. This Copay Program may not be redeemed more than once per 21 days. The Copay Program is not valid for patients whose prescription claims are reimbursed, in whole or in part, by any state or federal government program, including, but not limited to, Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, Puerto Rico Government Insurance, or any state patient or pharmaceutical assistance program. Offer is not valid for cash-paying patients. Patient must be a resident of the U.S., Puerto Rico, or U.S. Territories. This Copay Program is void where prohibited by state law and on the date an AB generic equivalent for ORGOVYX becomes available. Certain rules and restrictions apply. This offer is not insurance. This offer cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer. This offer is not conditioned on any past, present, or future purchase, including refills. Patient and participating pharmacists agree not to seek reimbursement for all, or any part of the benefit received by the patient through this Copay Program. Patient and participating pharmacists agree to report the receipt of Copay Program benefits to any insurer or other third party who pays for or reimburses any part of the prescription filled using the Card, as may be required by such insurer or third party. Sumitomo Pharma America reserves the right to revoke, rescind, or amend this offer without notice. The ORGOVYX Copay Program is valid through December 31, 2024.

ORGOVYX BRIDGE PROGRAM: TERMS AND CONDITIONS

The ORGOVYX Bridge Program ("Bridge Program") provides ORGOVYX at no cost for a limited period (up to 4 months) in a calendar year to eligible, commercially-insured patients, who have been prescribed ORGOVYX for an FDA-approved indication, and whose insurance coverage is delayed or who experience a temporary lapse in coverage. Prescribers must complete the Bridge Program prescription on the start form. By participating, patient acknowledges intent to pursue insurance coverage for ORGOVYX with their healthcare provider. Patients will receive their maintenance drug supply each month for up to 4 months or until they receive insurance coverage approval, whichever occurs earlier. The Bridge Program is not available for patients whose prescription claims are reimbursed, in whole or in part, by any state or federal government program, including, but not limited to, Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, Puerto Rico Government insurance, or any state patient or pharmaceutical assistance program. Patients must be residents of the United States or US Territories. The Bridge Program is not available to patients who are uninsured or where prohibited by law such as Massachusetts and Minnesota. Patients may be asked to reverify insurance coverage status during the course of the Bridge Program. Patients and participating prescribers agree not to seek reimbursement for all, or any part of the benefit received by the patient through this Bridge Program. No purchase necessary. The Bridge Program is not health insurance, nor is participation a guarantee of insurance coverage. Other limitations may apply. Sumitomo Pharma America reserves the right to rescind, revoke, or amend the Bridge Program and discontinue support at any time without notice.